Virtual reality enhanced mannequin (VREM) that is well received by resuscitation experts.

UNLABELLED: The objective of this study was to test acceptance of, and interest in, a newly developed prototype of virtual reality enhanced mannequin (VREM) on a sample of congress attendees who volunteered to participate in the evaluation session and to respond to a specifically designed questionnaire. METHODS: A commercial Laerdal HeartSim 4000 mannequin was developed to integrate virtual reality (VR) technologies with specially developed virtual reality software to increase the immersive perception of emergency scenarios. To evaluate the acceptance of a virtual reality enhanced mannequin (VREM), we presented it to a sample of 39 possible users. Each evaluation session involved one trainee and two instructors with a standardized procedure and scenario: the operator was invited by the instructor to wear the data-gloves and the head mounted display and was briefly introduced to the scope of the simulation. The instructor helped the operator familiarize himself with the environment. After the patient's collapse, the operator was asked to check the patient's clinical conditions and start CPR. Finally, the patient started to recover signs of circulation and the evaluation session was concluded. Each participant was then asked to respond to a questionnaire designed to explore the trainee's perception in the areas of user-friendliness, realism, and interaction/immersion. RESULTS: Overall, the evaluation of the system was very positive, as was the feeling of immersion and realism of the environment and simulation. Overall, 84.6% of the participants judged the virtual reality experience as interesting and believed that its development could be very useful for healthcare training. CONCLUSIONS: The prototype of the virtual reality enhanced mannequin was well-liked, without interfence by interaction devices, and deserves full technological development and validation in emergency medical training.

Strict normoglycaemic blood glucose levels in the therapeutic management of patients within 12h after cardiac arrest might not be necessary.

AIM OF THE STUDY: The admission blood glucose level after cardiac arrest is predictive of outcome. However the blood glucose levels in the post-resuscitation period, that are optimal remains a matter of debate. We wanted to assess an association between blood glucose levels at 12h after restoration of spontaneous circulation and neurological recovery over 6 months. MATERIALS AND METHODS: A total of 234 patients from a multi-centre trial examining the effect of mild hypothermia on neurological outcome were included. According to the serum glucose level at 12h after restoration of spontaneous circulation, quartiles (Q) were generated: Median (range) glucose concentrations were for QI 100 (67-115 mg/dl), QII 130 (116-143 mg/dl), QIII 162 (144-193 mg/dl) and QIV 265 (194-464 mg/dl). RESULTS: In univariate analysis there was a strong non-linear association between blood glucose and good neurological outcome (odds ratio compared to QIV): QI 8.05 (3.03-21.4), QII 13.41 (4.9-36.67), QIII 1.88 (0.67-5.26). After adjustment for sex, age, "no-flow" and "low-flow" time, adrenaline (epinephrine) dose, history of coronary artery disease and myocardial infarction, and therapeutic hypothermia, this association still remained strong: QI 4.55 (1.28-16.12), QII 13.02 (3.29-49.9), QIII 1.37 (0.38-5.64). CONCLUSION: There is a strong non-linear association of survival with good neurological outcome and blood glucose levels 12h after cardiac arrest even after adjusting for potential confounders. Not only strict normoglycaemia, but also blood glucose levels from 116 to 143 mg/dl were correlated with survival and good neurological outcome, which might have an important therapeutic implication.

Kids (learn how to) save lives in the school with the serious game Relive.

INTRODUCTION: Relive is a serious game focusing on increasing kids and young adults' awareness on CPR. We evaluated the use of Relive on schoolchildren. METHODS: A longitudinal, prospective study was carried out in two high schools in Italy over a 8-month period, divided in three phases: baseline, competition, and retention. Improvement in schoolchildren's CPR awareness, in terms of knowledge (MCQ results) and skills (chest compression (CC) rate and depth), was evaluated. Usability of Relive and differences in CC performance according to sex and BMI class were also evaluated. RESULTS: At baseline, students performed CC with a mean depth of 31mm and a rate of 95 cpm. In the competition phase, students performed CC with a mean depth of 46mm and a rate of 111 cpm. In the retention phase, students performed CC with a mean depth of 47mm and a rate of 131 cpm. Thus, the training session with Relive during the competition phase affected positively both CC depth (p<0.001) and rate (p<0.001). Such an effect persisted up to the retention phase. CC depth was also affected by gender (p<0.01) and BMI class (p<0.01). Indeed, CC depth was significantly greater in male players and in players with higher BMI. Seventy-three percent of students improved their CPR knowledge as represented by an increases in the MCQ score (p<0.001). The participants perceived the Relive to be easy to use with effective feedback. CONCLUSIONS: Relive is an useful tool to spread CPR knowledge and improve CPR skills in schoolchildren.

Retention of CPR performance in anaesthetists.

UNLABELLED: The objective of this study was to evaluate retention of ALS knowledge and performance among anaesthesiologists, who, in Italy, respond to in-hospital emergencies as team leaders. METHODS: 47 anaesthesiologists (23 consultants and 24 residents) were invited at one weeks notice to attend a re-evaluation session, 6 months after successful completion of an ERC ALS course. Knowledge retention was assessed by a multiple choice question test, and skills and management by evaluation of performance as team leader in one of the six standardized CAStest scenarios. During the performance, the timeliness of first defibrillation, completion of the three shock sequence, adrenaline (epinephrine) administration and intubation were recorded. Results were compared between consultants and residents. RESULTS: Compared to the results at the end of the ALS course, the percent of correct answers to the multiple choice question test decreased from 85.89 +/- 5.28% to 79.45 +/- 6.62% (P < 0.001), the number of candidates achieving a pass performance decreased from 47/47 to 30/47 (P < 0.001). Time to first defibrillation was 73.38 +/- 18.72 s, time for completion of the third defibrillation was 113.04 +/- 35.58 s and subsequent ALS interventions were very delayed or forgotten. Comparison between consultants and residents showed that consultants retained knowledge information better, skills decreased comparably in both groups and residents performed tasks faster. CONCLUSIONS: The significant decay of ALS skills 6 months post-ALS recorded among anaesthesiologists supports the need for periodical reinforcement during intervals before recertification.

Advanced life support provider course in Italy: A 5-year nationwide study to identify the determinants of course success.

INTRODUCTION: The advanced life support (ALS) provider course is the gold standard for teaching and assessing competence in advanced resuscitation. Outcomes over a 5-year period of European Resuscitation (ERC)/IRC ALS provider courses in Italy were investigated, and the factors associated with course success are described. METHODS: In 2008, the Italian Resuscitation Council (IRC) created a database in which every ERC/IRC ALS course was recorded. Data from courses organized from 2008 to 2012 were analysed. The data included: candidate's age and degree (medical doctor (MD) or nurse), medical specialty of MD candidates, course outcomes, duration and reference guidelines, number of instructors and course director. Relationships between the course outcomes and the courses and candidates' characteristics were analysed using logistic regression. RESULTS: A total of 13,624 candidates were evaluated from 871 courses. Among the candidates, 55% were MDs and 45% were nurses. Ninety-seven percent of candidates passed the final evaluation, while 3% failed. Candidates who passed were younger (37 [31-44] vs. 43 [37-50] years, p<0.0001) and had a greater pre-course resuscitation knowledge (multiple choice quiz (MCQ) score: 88 [83-93] vs. 80 [73-87], p<0.0001) compared to those who failed. The course pass rate was higher for MDs compared to nurses (98% vs. 95%, p<0.0001) and participants in emergency disciplines were most significantly associated with course success (χ(2) 71, p<0.0001). In the multivariate analysis, an older age (OR 0.926, 95%CI [0.915-0.937]) was independently associated with course failure, while being a MD (OR 3.021, 95%CI [2.212-4.132]), having a higher pre-course MCQ score (OR 1.033, 95%CI [1.026-1.040]) together with a higher candidate/instructor ratio (OR 1.314, 95%CI [1.067-1.618]), and having a longer course duration (OR 1.717, 95%CI [1.090-2.703]), were independently associated with success. CONCLUSIONS: Younger age, professional background, and pre-course resuscitation knowledge are the most important predictors of ALS provider course success, together with higher candidate/instructor ratios and longer course durations.

[Implementation of post-resuscitation care in adult cardiac arrest patients - Experts' opinion]. / Implementazione del trattamento post-rianimazione da arresto cardiaco nell'adulto - Opinione di un panel di esperti.

Current evidence on post-resuscitation care suffers from important knowledge gaps on new treatments and prognostication, mainly because of the lack of large multicenter randomized trials. However, optimization of post-resuscitation care is crucial, and the establishment of a treatment easy to be accepted and implemented locally, based on currently available evidence, is advisable. The present article is a multisociety experts' opinion on post-cardiac arrest that aims (i) to provide schematic and clear suggestions on therapeutic interventions to be delivered following resuscitation from cardiac arrest, so as to implement local protocols with a standardized post-resuscitation care; (ii) to suggest post-resuscitation therapeutic interventions that may result in improved survival with good neurological recovery, intended as a Cerebral Performance Category (CPC) score of 1-2; and finally (iii) to propose a pragmatic and schematic approach to post-resuscitation care for rapid initiation of intensive treatments (i.e. temperature management). The suggestions reported in this document are intended for adult patients resuscitated from both out-of-hospital and in-hospital cardiac arrest. They should be considered solely as an experts' opinion aimed to improve post-cardiac arrest care and they do not represent an official national guideline.

Motion detection technology as a tool for cardiopulmonary resuscitation (CPR) quality training: a randomised crossover mannequin pilot study.

INTRODUCTION: Outcome after cardiac arrest is dependent on the quality of chest compressions (CC). A great number of devices have been developed to provide guidance during CPR. The present study evaluates a new CPR feedback system (Mini-VREM: Mini-Virtual Reality Enhanced Mannequin) designed to improve CC during training. METHODS: Mini-VREM system consists of a Kinect(®) (Microsoft, Redmond, WA, USA) motion sensing device and specifically developed software to provide audio-visual feedback. Mini-VREM was connected to a commercially available mannequin (Laerdal Medical, Stavanger, Norway). Eighty trainees (healthcare professionals and lay people) volunteered in this randomised crossover pilot study. All subjects performed a 2 min CC trial, 1h pause and a second 2 min CC trial. The first group (FB/NFB, n=40) performed CC with Mini-VREM feedback (FB) followed by CC without feedback (NFB). The second group (NFB/FB, n=40) performed vice versa. Primary endpoints: adequate compression (compression rate between 100 and 120 min(-1) and compression depth between 50 and 60mm); compressions rate within 100-120 min(-1); compressions depth within 50-60mm. RESULTS: When compared to the performance without feedback, with Mini-VREM feedback compressions were more adequate (FB 35.78% vs. NFB 7.27%, p<0.001) and more compressions achieved target rate (FB 72.04% vs. 31.42%, p<0.001) and target depth (FB 47.34% vs. 24.87%, p=0.002). The participants perceived the system to be easy to use with effective feedback. CONCLUSIONS: The Mini-VREM system was able to improve significantly the CC performance by healthcare professionals and by lay people in a simulated CA scenario, in terms of compression rate and depth.

iCPR: a new application of high-quality cardiopulmonary resuscitation training.

OBJECTIVES: The present study evaluates a new CPR feedback application for the iPhone (iCPR) designed to improve chest compression performance tested in a cardiac arrest simulation to evaluate performance and acceptance by healthcare professionals and lay people. METHODS: We built an application specifically dedicated to self-directed CPR training through a tutorial that includes a simple feedback module to guide training in order to improve the quality of chest compressions. We tested it in a sample of 50 users to evaluate the effect of iCPR on performance and it is acceptance. The participants were randomly assigned to one of the study groups and were asked to perform a trial of 2 min of chest compressions (CC), to answer a predefined set of questions and then to perform two more minutes of CC. The first group performing the sequence of CC with iCPR - questions - CC without feedback, and the second the sequence CC without feedback - questions CC with iCPR. RESULTS: The mean compression rate was 101±2.8 min(-1) when CC were performed with iCPR and 107.8±20.5 min(-1) when performed without iCPR (p<0.01). Overall, the participants considered iCPR useful to maintain CC at the desired rate of 100 compressions per minute. CONCLUSIONS: The iCPR feedback tool was able to significantly improve the performance of chest compressions in terms of the compression rate in a simulated cardiac arrest scenario. The participants also believed that iCPR helped them to achieve the correct chest compression rate and most users found this device easy to use.

"Identifying the hospitalised patient in crisis"--a consensus conference on the afferent limb of rapid response systems.

BACKGROUND: Most reports of Rapid Response Systems (RRS) focus on the efferent, response component of the system, although evidence suggests that improved vital sign monitoring and recognition of a clinical crisis may have outcome benefits. There is no consensus regarding how best to detect patient deterioration or a clear description of what constitutes patient monitoring. METHODS: A consensus conference of international experts in safety, RRS, healthcare technology, education, and risk prediction was convened to review current knowledge and opinion on clinical monitoring. Using established consensus procedures, four topic areas were addressed: (1) To what extent do physiologic abnormalities predict risk for patient deterioration? (2) Do workload changes and their potential stresses on the healthcare environment increase patient risk in a predictable manner? (3) What are the characteristics of an "ideal" monitoring system, and to what extent does currently available technology meet this need? and (4) How can monitoring be categorized to facilitate comparing systems? RESULTS AND CONCLUSIONS: The major findings include: (1) vital sign aberrations predict risk, (2) monitoring patients more effectively may improve outcome, although some risk is random, (3) the workload implications of monitoring on the clinical workforce have not been explored, but are amenable to study and should be investigated, (4) the characteristics of an ideal monitoring system are identifiable, and it is possible to categorize monitoring modalities. It may also be possible to describe monitoring levels, and a system is proposed.